Neck Pain

Topic Overview

What is neck pain?

Neck pain can occur anywhere in
your neck, from the bottom of your head to the top of your shoulders. It can
spread to your upper back or arms. It may limit how much you can move your head
and neck.

Neck pain is common, especially in people older than
50.

What causes neck pain?

Most neck pain is caused by
activities that strain the neck. Slouching, painting a ceiling, or sleeping
with your neck twisted are some things that can cause neck pain. These kinds of
activities can lead to neck strain, a sprain, or a spasm of the neck muscles.

Neck pain can also be caused by an injury. A
fall from a ladder or
whiplash from a car accident can cause neck pain. Some
less common medical problems can also lead to neck pain, such as:

What are the symptoms?

You may feel a knot,
stiffness, or severe pain in your neck. The pain may spread to your shoulders,
upper back, or arms. You may get a headache. You may not be able to move or
turn your head and neck easily. If there is pressure on a
spinal nerve root, you might have pain that shoots
down your arm. You may also have numbness, tingling, or weakness in your
arm.

If your neck pain is long-lasting (chronic), you may have
trouble coping with daily life. Common side effects of chronic pain include
fatigue,
depression, and
anxiety.

How is neck pain diagnosed?

Your doctor will ask
questions about your symptoms and do a physical exam. He or she may also ask
about any injuries, illnesses, or activities that may be causing your neck
pain.

During the physical exam, your doctor will check how well
you can move your neck. He or she will also look for tenderness or numbness,
tingling, or weakness in your arms or hands.

If your pain started
after an injury, or if it doesn't improve after a few weeks, your doctor may
want to do more tests.
Imaging tests such as an
X-ray, an
MRI scan, or a
CT scan can show the neck muscles and tissues. These
tests may be done to check the neck bones,
spinal discs, spinal nerve roots, and
spinal cord.

How is it treated?

The type of treatment you need
will depend on whether your neck pain is caused by activities, an injury, or
another medical condition. Most neck pain caused by activities can be treated
at home.

For neck pain that occurs suddenly:

Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. Or you can try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help. But you can try them to see if they help.

Take
acetaminophen (such as Tylenol). Ibuprofen or another
anti-inflammatory medicine can also help relieve
pain.

Avoid more injury to your neck by changing activities and
habits, such as how you sit or sleep.

Try exercises or
manual therapy to help you move your head
and neck more easily. See a physical therapist, chiropractor, or osteopathic doctor for this type of care.

To treat chronic neck pain, your doctor may prescribe
medicine to relax your neck muscles. Or you may get medicines to relieve pain
and help you sleep. You might also try massage or yoga to relieve neck
stress.

Surgery is rarely done to treat neck pain. But it may be
done if your pain is caused by a medical problem, such as pressure on the
spinal nerve roots, a tumor, or narrowing of the spinal canal.

Can you prevent neck pain?

You can avoid neck pain
caused by stress or muscle strain with some new habits. Avoid spending a lot of
time in positions that stress your neck. This can include sitting at a computer
for a long time.

If your neck pain is worse at the end of the
day, think about how you sit during the day. Sit straight in your chair with
your feet flat on the floor. Take short breaks several times an hour.

If your neck pain is worse in the morning, check your pillow and the
position you sleep in. Use a pillow that keeps your neck straight. Avoid
sleeping on your stomach with your neck twisted or bent.

Cause

Neck pain can be caused by:

An activity
that harms the neck.

An injury.

Another medical condition.

Activities that cause neck pain

Most neck pain is
caused by activities that involve repeated or prolonged movements of the
neck. This can result in a
strain (an overstretched or overused muscle), a
sprain (injury to a ligament), or a spasm of the neck
muscles.

These
activities include:

Holding your head in a forward or odd position for long periods
of time while working, reading, watching TV, or talking on the telephone.

Sleeping on a pillow that is too high
or too flat or that doesn't support your neck, or sleeping on your stomach with your
neck twisted or bent.

Spending long periods of time resting your head on your
upright fist or arm.

Work or exercise that uses the upper body and arms, such as
painting a ceiling or other overhead work.

Stress and focusing intensely on a task can also cause neck pain. Tension may develop in one or more of the muscles that connect the
head, neck, and shoulders. They may feel tight and painful.

Injuries that cause neck pain

Minor injuries may occur from tripping or
falling a short distance or from excessive motion of the
cervical spine.

Torticollis (wryneck). Torticollis is caused by severe
muscle tightness or a shortened muscle on one side of the neck, causing the
head to be tilted to one side. Torticollis is usually a symptom of another
medical problem.

Referred pain. Referred pain occurs when a problem in
one place in the body causes pain in another place. For example, a problem with
your jaw (
temporomandibular disorder) or your heart (such as a
heart attack) can cause neck pain.

A burning feeling when you are touched on the skin of the arm or hand.

A pain that feels like a shock and extends into your arm or
hand.

Leg numbness or weakness, and loss of the ability to control
urination (bladder control) or bowel movements. This can occur when
there is pressure on or injury to the spinal cord.

What Happens

Most neck pain gets better within several weeks with treatment that includes
taking steps to relieve pain, modifying activities, and doing exercises or
manual therapy. Neck pain caused by an injury such as a severe
whiplash may take longer but usually improves in 6
to 12 months.

Chronic neck pain

Neck pain may become long-lasting (chronic) when it occurs in combination
with other health conditions, such as conditions associated with increasing
age. These include narrowing of the spinal canal (
cervical spinal stenosis ), arthritis of the neck (
cervical spondylosis ), or
herniated disc . In some cases, chronic neck pain can be caused by repeated
and prolonged movements, such as long hours working at a computer.

Chronic neck pain can make it hard to cope with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety. For more
information, see the topic
Chronic Pain .

What Increases Your Risk

Risk factors for
neck pain that you cannot control include:

Age. People who are middle-aged or older are more likely to have breakdown
(degeneration) of
discs or
joints, as well as bone spurs in the
vertebrae of the neck (
cervical spondylosis ).

Recent injury or history of injury. A common injury to the neck
is
whiplash caused by a car accident.

Exams and Tests

Initial testing

Neck pain is
usually evaluated with a medical history and physical exam. Your doctor
will ask about your symptoms, injuries or illnesses, any previous treatment,
and habits and activities that may be causing your neck pain. During the
physical exam, your doctor will check your neck's range of motion and check for
pain caused by movement. He or she will look for areas of tenderness and any
nerve-related changes, such as
numbness, tingling, or weakness in the arm or hand.

Blood tests may be done to check for an illness or
infection.

Imaging, electromyogram, and nerve conduction tests

You may not need X-rays or other
imaging tests. But tests may help if your neck pain doesn't get better, especially when:

You have signs of nerve damage.

Another serious problem is suspected.

The cause of your condition cannot be clearly
identified.

Nonsurgical treatment has not improved your condition and you are considering surgery.

Your doctor is asked to provide documentation of your
condition, such as when a lawsuit or an insurance issue is involved.

Treatment Overview

Most neck pain is
caused by activities that involve repeated or prolonged movements of the
neck. Nonsurgical treatment works well on this type of pain. Most cases of neck pain caused by activities get better in 4 to 6 weeks.footnote 1

Acute (short-term) neck pain

Home treatment includes applying heat or ice, taking it easy but staying as active as you can, and using over-the-counter pain relievers.

Chronic (long-term) neck pain

People who have
chronic pain syndrome and its associated problems,
such as
depression or drug dependence, may respond to
treatment more slowly. Counseling along with medical treatment may help in
recovery.

Surgery

Surgery is
rarely required for neck pain. It may be an option when neck pain is caused
by certain conditions.

Prevention

For neck pain caused by posture or body mechanics

Avoid slouching or a head-forward posture. Sit straight in
your chair with your lower back supported, feet flat on the floor, and
shoulders relaxed. Don't sit for long periods without getting up or
changing positions. Take short breaks several times an hour to
stretch your neck muscles.

If you
work at a computer, adjust the monitor so the top of
the screen is at eye level. Use a document holder that puts your work at the
same level as the screen. For more information, see the topic
Office Ergonomics .

If you use the telephone a lot, use a headset or
speaker phone. Don't cradle the phone on your shoulder.

Adjust the seat of your car to a more upright position that supports
your head and lower back. Make sure that you are not reaching for the steering
wheel while driving. Your arms should be in a slightly flexed, comfortable
position.

For neck pain caused by sleep habits

Use a
pillow that keeps your neck straight. Special neck support pillows called cervical pillows or rolls may
relieve neck stress. You can also fold a towel lengthwise into a pad that is
4 in. (10 cm) wide, wrap it
around your neck, and pin it in position for good support.

Don't sleep on your stomach with your neck twisted or
bent.

If you read in bed, prop up the book so you aren't using
your arms to hold it up and bending your neck forward. Consider using a
wedge-shaped pillow to support your arms and keep your neck in a neutral
position.

Corticosteroid injections. These are rarely used for neck pain. But they may be tried if you also have symptoms such as pain or numbness in your arm that suggests a nerve root is pinched or irritated (radiculopathy).

Surgery

Surgery is
rarely needed for neck pain. It may be an option when:

A neck injury causes a fracture or
abnormal motion (instability). Surgery may be done to stabilize the spine and
prevent a bone fracture from causing instability and possible paralysis.

Some people can
consider artificial disc replacement instead of spinal fusion. This surgery is currently just for carefully selected
patients, and it is done by specially trained surgeons. Doctors have not yet
done long-term studies to know how well this works over time.

Other Treatment

Other types of treatment for
neck pain may help relieve your symptoms, restore
movement, and strengthen the muscles around your spine to help prevent further
injury.

Other treatment choices

Other types of treatment include:

Cervical (neck) collars. These may be used for short
periods of time to help reduce pain by restricting neck movement.

Traction. This is a technique used to stretch the neck and relax the
spinal nerve root openings. It may be used if there
is no risk of instability in the neck. There is not strong evidence that traction helps.footnote 3

Low-level laser therapy. This uses targeted light energy to decrease pain and promote healing. A review of studies suggests that it can help both sudden (acute) and long-term (chronic) neck pain.footnote 4

Radiofrequency ablation (or percutaneous radiofrequency neurotomy). The purpose of this procedure is to interrupt the pain signal as it travels through the nerve. There is not strong evidence that this helps.footnote 2

Complementary and alternative treatments

Complementary and alternative treatments are sometimes used to relieve
pain and restore neck mobility. They include:

Massage, to help with relaxation, decreased pain, and
increased flexibility.

Yoga or
qi gong, which are programs of exercises to help improve
flexibility and breathing, decrease stress, and maintain health.

Acupuncture, which is done by inserting very thin
needles into the skin. Acupuncture is used to relieve pain and to treat many
health conditions.

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